Medical Necessity

Recently I retired from a career that involved making determinations of "medical necessity" for hospitalized patients. Soon I lost a dear friend in the fifth decade of her life, and now I sit here, wondering if the definition of "medical necessity" was in some way responsible for her death. Just two years ago, certain procedures and treatments based on professional technique and observation determined the need for hospitalization. Today, because of demands by the health insurance industry,...

Just as Naperville's planning and zoning commissioners did not all agree on issues related to the regulation of medical marijuana, city councilmen have differing viewpoints on a proposed ordinance. The Compassionate Use of Medical Cannabis Pilot Program Act takes effect Jan. 1 throughout the state. Naperville city lawmakers are taking advantage of their option to impose further restrictions should a dispensary or cultivation center seek to open in town. Following two rounds...

The recent Tribune article "Hospitals overcharge Medicare, probers say" shows a very unbalanced view regarding hospitals "overcharging" Medicare. The authority to admit and discharge patients as a rule lies with the attending physician and not with a hospital or its administration. The reasons for retrospective denial are often based upon technical rationale rather than medical necessity. Denial does not imply "overcharging" but rather a difference of opinion on medical severity.

ATLANTA (Reuters) - A 15-year-old Atlanta boy went on the waiting list for a heart transplant two days after his family complained he was unfairly rejected because of past failure to take medicine and show up for doctor's appointments, his family told a TV station on Tuesday. Anthony Stokes has an enlarged heart and could have less than six months to live without a transplant, his family said. Relatives told Atlanta television station WSB that Children's...

THE SUPREME COURT. Arguing that the distribution of marijuana for medical purposes undermines the nation's drug laws and leads to abuse, the government on Wednesday urged the Supreme Court to stop a California cooperative from dispensing the drug to the seriously ill. But a lawyer for a medical marijuana club maintained that it merely wants to hand out a "lifesaving drug" that is necessary to alleviate suffering. For many people suffering from diseases such as AIDS and cancer,...

GUANTANAMO BAY U.S. NAVAL BASE, Cuba (Reuters) - U.S. Senator Dianne Feinstein urged the Pentagon on Wednesday to stop force-feeding hunger-striking prisoners at the Guantanamo Bay detention camp and called the practice "out of step" with medical ethics and international norms. Feinstein, a California Democrat who chairs the Senate intelligence committee, sent a letter to Defense Secretary Chuck Hagel, saying the Guantanamo force-feeding policy was also out of synch with policies...

The focus of a fierce suburban congressional battle turned from the economy to abortion literally overnight following Republican Rep. Joe Walsh's controversial declaration that there's no medical necessity to use the procedure to save a woman's life. "With modern technology and science, you can't find one instance," Walsh declared in comments to reporters after a televised debate Thursday night against Democrat Tammy Duckworth in the northwest suburban 8th District race. By Friday...

Name: Ronna Fisher, Au.D Age: 55 Hometown: Pittsburgh Name of business: Hearing Health Center Describe what you do. We provide patients with the ability to, once again, participate in activities they ceased enjoying (movies, bridge, theater, parties) because they couldn't hear. We also diagnose and treat patient's that are dizzy or have balance problems and provide ear protection for every type of profession (musicians, dentists, printers) and recreational...

* HCA internal inquiry found evidence of unnecessary treatments-NYT * Procedures performed at some of company's Florida hospitals-paper Aug 6 (Reuters) - Prompted by a nurse's complaint, hospital operator HCA Holdings Inc launched an internal investigation that uncovered evidence some of its cardiologists were performing unnecessary heart procedures on patients, the New York Times reported on Monday. HCA, the largest U.S. for-profit hospital chain,...

The focus of a fierce suburban congressional battle turned from the economy to abortion literally overnight following Republican Rep. Joe Walsh's controversial declaration that there's no medical necessity to use the procedure to save a woman's life. "With modern technology and science, you can't find one instance," Walsh declared in comments to reporters after a televised debate Thursday night against Democrat Tammy Duckworth in the northwest suburban 8th District race. By Friday...

A tentative deal has been reached that will send the rights to restricted free agent Eric Lindros to the Edmonton Oilers from the Philadelphia Flyers, the New York Times reported in Wednesday's editions. According to an unnamed league executive, Lindros has told the Flyers he will not play for Edmonton. Lindros seemed to be surprised when told the two sides were working on a deal. "I have not heard anything about this," Lindros said when reached by phone Tuesday night. "I don't think it is...

* HCA internal inquiry found evidence of unnecessary treatments-NYT * Procedures performed at some of company's Florida hospitals-paper Aug 6 (Reuters) - Prompted by a nurse's complaint, hospital operator HCA Holdings Inc launched an internal investigation that uncovered evidence some of its cardiologists were performing unnecessary heart procedures on patients, the New York Times reported on Monday. HCA, the largest U.S. for-profit hospital chain,...

Gov. Edgar should learn to leave well enough alone. He has supported and signed a bill mandating coverage for in vitro fertilization. There would seem to be no logic associated with covering that expense in the medical policies of firms with more than 25 employees. This procedure is not a medical necessity. It is elective, and a lot easier to elect when the rest of us are picking up the tab. While I can sympathize with married couples who can`t procreate, their health is not imperiled by a lack of this...

By Jane Sutton GUANTANAMO BAY U.S. NAVAL BASE, Cuba, June 19 (Reuters) - U .S. Senator Dianne Feinstein urged the Pentagon on Wednesday to stop force-feeding hunger-striking prisoners at the Guantanamo Bay detention camp and called the practice "out of step" with medical ethics and international norms. Feinstein, a California Democrat who chairs the Senate intelligence committee, sent a letter to Defense Secretary Chuck Hagel, saying the Guantanamo...

U.S. authorities are looking into billing practices and the medical necessity of heart procedures performed at hospitals operated by HCA Holdings Inc., the company revealed in a regulatory filing on Monday. HCA, in an unusual move, also issued a detailed rebuttal defending itself against a not-yet, published report by The New York Times in which it said it believes the newspaper will question physician decisions at its hospitals regarding certain heart procedures. HCA...

Kerry and Allan Klein of Lincolnwood talked to their obstetrician recently about the possibility of using drugs to send Kerry into labor early so that she could have the couple's first baby before Allan started a new job that would take him out of town. For the Kleins, who are Jewish, an added incentive to timing the birth was that if the baby was a boy, his ritual circumcision would fall on a Sunday. The pair were inquiring about what is called a "social...